Physical therapy system

ABSTRACT

A method for stimulating contraction of a target muscle, the method including: locating a first neuromuscular junction of a target muscle by visualization or palpation, delivering a first stimulus to the first neuromuscular junction, locating a second neuromuscular junction of the target muscle by visualization or palpation, and delivering a second stimulus to the second neuromuscular junction. The first and second stimuli are effective to stimulate contraction of the target muscle. Further, contraction of the target muscle is effective to result in a measurable increase of at least one of: output force of the target muscle or range of motion of a body part associated with extension or contraction of the target muscle.

FIELD OF THE INVENTION

A physical therapy system including a method useful in increasing musclecontrol or decreasing neuromuscular inhibition of a target muscle.

II. BACKGROUND OF THE INVENTION

Conventional physical therapy may be used to aid a subject havingimpaired muscle control, which may include general manipulation of themuscle to increase muscle relaxation. Typically, a provider may workwith a subject to determine limitations in muscle control by assessingmuscle length and gross strength. Subsequently, the provider may providethe subject with a preferred set of exercises targeted toward increasinggross strength of the impaired muscle. This approach may focus onalleviating symptoms of pain, swelling, tightness, or the like, asopposed to focusing on the underlying cause of these symptoms to restorenormal physiologic function and biomechanics of muscle control.

The underlying cause of symptoms related to impaired muscle control suchas pain, swelling, tightness, or the like, may be neuromuscularinhibition resulting from an incomplete or complete inhibition ofneuromuscular transmission. Generally, neuromuscular transmission occursat a neuromuscular junction, where neurotransmitters can be releasedfrom a prejunctional nerve ending, traverse a synapse, and bind toreceptors on a postjunctional muscle membrane. Overall, theneuromuscular transmission signaling cascade can result in the transferof an action potential from a motor neuron to a muscle fiber, resultingin muscle contraction. However, when the function of one or morecomponents of the neuromuscular transmission signaling cascade iscompromised, neuromuscular transmission may be either partially orcompletely inhibited.

Because conventional methods focus on alleviating symptoms of impairedmuscle control and may not focus on modulating neuromusculartransmission, there would be an advantage in an inventive method whichacts to increase muscle control or modulate the neuromusculartransmission signaling cascade to decrease neuromuscular inhibition,which in turn can act to increase muscle control.

III. SUMMARY OF THE INVENTION

Accordingly, a broad object of the invention can be to provide aphysical therapy system which includes methods useful in increasingmuscle control of a target muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in decreasing neuromuscularinhibition of a target muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in increasing neuromusculartransmission of a target muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in stimulating contractionof a target muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in alleviating one or moresymptoms associated with loss of muscle control.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in alleviating symptomsincluding pain, swelling, tightness, or the like, or combinationsthereof.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in increasing the outputforce of a target muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in increasing the range ofmotion of a body part associated with extension or contraction of atarget muscle.

Another broad object of the invention can be to provide a physicaltherapy system which includes methods useful in restoring normalphysiologic function, biomechanics, or the like, or combinationsthereof.

Naturally, further objects of the invention are disclosed throughoutother areas of the specification, drawings, and claims.

IV. BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 provides a flow diagram of a method included in a particularembodiment of the inventive physical therapy system.

FIG. 2A shows an exemplary neuromuscular transmission cascade that canbe modulated by methods of the inventive physical therapy system.

FIG. 2B shows an exemplary neuromuscular transmission cascade that canbe modulated by methods of the inventive physical therapy system.

FIG. 2C shows an exemplary neuromuscular transmission cascade that canbe modulated by methods of the inventive physical therapy system.

FIG. 3 shows an exemplary method of using a particular embodiment of theinventive physical therapy system.

FIG. 4 shows an exemplary method of using a particular embodiment of theinventive physical therapy system.

FIG. 5 shows exemplary elements of a method included in a particularembodiment of the inventive physical therapy system.

FIG. 6 shows an exemplary measureable result of a method included in aparticular embodiment of the inventive physical therapy system.

FIG. 7 shows an exemplary method of using a particular embodiment of theinventive physical therapy system.

FIG. 8 shows exemplary elements of a method included in a particularembodiment of the inventive physical therapy system.

FIG. 9 shows an exemplary method of using a particular embodiment of theinventive physical therapy system.

FIG. 10 shows exemplary elements of a method included in a particularembodiment of the inventive physical therapy system.

FIG. 11 provides a graph illustrating the percent increase in rectusfemoris muscle output force following administration of a methodincluded in a particular embodiment of the inventive physical therapysystem.

FIG. 12 provides a flow diagram of a method included in a particularembodiment of the inventive physical therapy system.

FIG. 13 provides a flow diagram of a method included in a particularembodiment of the inventive physical therapy system.

V. DETAILED DESCRIPTION OF THE INVENTION

Now referring generally to FIG. 1 through FIG. 13, which illustrate aninventive physical therapy method (1) useful in increasing musclecontrol, which can result from decreasing neuromuscular inhibition of atarget muscle (3) of a subject (4).

Now referring primarily to FIG. 1, embodiments of the inventive methodcan include one or more of: locating a target muscle (5), locating atarget muscle end, locating a target muscle location (7) a distance fromthe target muscle end (9), and providing a stimulus (10) to the targetmuscle location (11), the stimulus (12) operable to increase musclecontrol (13) or decrease neuromuscular inhibition (14) of the targetmuscle (3).

The term “target muscle” for the purposes of this invention means anyband or bundle of fibrous tissue in a human or animal body that has theability to contract.

The term “neuromuscular inhibition” for the purposes of this inventionmeans an incomplete or complete inhibition of neuromusculartransmission.

The term “neuromuscular transmission” for the purposes of this inventionmeans an event occurring at a neuromuscular junction including thetransmission of a neurotransmitter from an end of a neuron to a receptoron a muscle.

The term “muscle control” for the purposes of this invention means theability to contract one or more muscles.

Now referring primarily to FIG. 2A, FIG. 2B, and FIG. 2C, whichgenerally illustrate neuromuscular transmission, a neuron (15) cansynthesize neurotransmitters (16) (for example, acetylcholine) and canstore the neurotransmitters (16) in synaptic vesicles (17). Arrival ofan action potential (18) at the synaptic end bulb (19) can function toopen voltage-gated calcium ion (Ca²⁺) channels (20), which can result ina subsequent increase in the concentration of intracellular Ca²⁺ (21).This increased intracellular Ca²⁺ (21) concentration can trigger acascade of signaling events operable to facilitate migration of theneurotransmitter-containing synaptic vesicles (17) to the periphery ofthe synaptic end bulb (16) of the neuron (15), where theneurotransmitter-containing synaptic vesicles (17) can rupture andrelease the neurotransmitters (16) into the synaptic cleft (22). Theneurotransmitters (16) can bind to neurotransmitter receptors (23)located on the motor endplate (24) of a myocyte (25), consequentlyactivating the neurotransmitter receptors (23), which can respond byopening voltage-gated sodium ion (Na⁺) channels (26), allowing an influxof Na⁺ (27) into the myocyte (25). The Na⁺ (27) influx can depolarizethe motor endplate (24), which can generate and propagate an actionpotential (18), leading to muscle contraction.

Now referring generally to FIG. 3 through FIG. 10, with respect tolocating a target muscle (5) within the body of a subject (4), thesubject (4) can be positioned on a support surface (28) to provideaccess to the target muscle (3) (as shown in the examples of FIG. 3,FIG. 4, FIG. 7, and FIG. 9). The position of the subject (4) useful invarious embodiments of the inventive method can vary depending upon thespecific target muscle (3) and as illustrative examples, can include:standing, sitting, long-sitting, squatting, lying (supine or prone),side-lying, kneeling, crouching, static crawling, or the like, orcombinations thereof.

The target muscle (3) can be located by visualization, palpation, or thelike, or combinations thereof; however, this description is not intendedto limit locating the target muscle (5) solely to these procedures.Visualization of a target muscle (3) can be accomplished by an eyewhether assisted or unassisted by optics. Visualization of a targetmuscle (3) can be facilitated by having a subject (4) lengthen andcontract the target muscle (3) one or a plurality of times, therebydistinguishing the target muscle (3) from the surrounding tissue.Additionally, target muscle (3) visualization can be accomplished bymedical imaging, including as illustrative examples, techniques such asradiology, which can use imaging technologies including X-rayradiography, magnetic resonance imaging, medical ultrasonography orultrasound, endoscopy, elastography, tactile imaging, thermography,medical photography, nuclear medicine functional imaging techniques, 3-Dmotion-capture imaging, or the like, or combinations thereof.

As to particular embodiments, palpation can be used to locate a targetmuscle (3). Palpation can include manual palpation, which can be anexamination by touch, an act of touching, feel, or an act of feeling ofa surface of a subject (4) to determine a location or a condition of aportion of the subject (4) beneath the surface of the subject (4), suchas a target muscle (3). In addition, palpation can include virtualpalpation, for example haptic palpation. Palpation of a target muscle(3) can be facilitated by having a subject (4) lengthen and contract thetarget muscle (3) one or a plurality of times, thereby distinguishingthe target muscle (3) from the surrounding tissue.

Again referring generally to FIG. 3 through FIG. 10, the inventivemethod can further include locating a target muscle end. A target muscle(3) can include a target muscle belly (29) longitudinally disposedbetween a target muscle first end (30) and a target muscle second end(31). Each target muscle end (30)(31) can be correspondingly joined to abone (32) by a tendon (33) (as shown in the examples of FIG. 5, FIG. 8,and FIG. 10).

Again referring primarily to FIG. 3 through FIG. 10, the inventivemethod can further include locating a target muscle location (7) on thetarget muscle (3) (or “a target muscle first location” and “a targetmuscle second location” and so forth) which can act, when stimulated, toincrease muscle control (13) or decrease neuromuscular inhibition (14)of the target muscle (3) of a subject (4).

As to particular embodiments, a target muscle first location can belocated a first distance from the target muscle first end (30). Thefirst distance from the target muscle first end (30) can be in a rangeof between about 0.5 inches to about 6 inches. The first distance can beone or more of the distances selected from the group including orconsisting of: between about 0.5 inches to about 1.5 inches, betweenabout 1.0 inch to about 2.0 inches, between about 1.5 inches to about2.5 inches, between about 2.0 inches to about 3.0 inches, between about2.5 inches to about 3.5 inches, between about 3.0 inches to about 4.0inches, between about 3.5 inches to about 4.5 inches, between about 4.0inches to about 5.0 inches, between about 4.5 inches to about 5.5inches, and between about 5.0 inches to about 6.0 inches. As anillustrative example, the first distance can be about one inch from thetarget muscle first end (30).

As to particular embodiments, a target muscle second location can belocated a second distance from the target muscle second end (31). Thesecond distance from the target muscle second end (31) can be in a rangeof between about 0.5 inches to about 6 inches. The second distance canbe one or more of the distances selected from the group including orconsisting of: between about 0.5 inches to about 1.5 inches, betweenabout 1.0 inch to about 2.0 inches, between about 1.5 inches to about2.5 inches, between about 2.0 inches to about 3.0 inches, between about2.5 inches to about 3.5 inches, between about 3.0 inches to about 4.0inches, between about 3.5 inches to about 4.5 inches, between about 4.0inches to about 5.0 inches, between about 4.5 inches to about 5.5inches, and between about 5.0 inches to about 6.0 inches. As anillustrative example, the second distance can be about one inch from thetarget muscle second end (31).

As to particular embodiments, the target muscle location (11) can bedistinguished as a discrete location from the surrounding locations onthe target muscle (3) because when stimulated, the target musclelocation (11) can act to increase muscle control (13) of the targetmuscle (3) of the subject (4) or can act to decrease neuromuscularinhibition (14) of the target muscle (3) of the subject (4). Typically,the target muscle location (11) will be discrete from the target muscleends (30)(31), which generally comprise the origin of the target muscle(3) and the insertion of the target muscle (3). Both the origin andinsertion of the target muscle (3) can include a Golgi Tendon Organ,which may not be associated with increased muscle control (13) of thetarget muscle (3) or neuromuscular transmission. Thus, stimulationprovided to the origin or insertion of the target muscle (3) may notincrease muscle control (13) or decrease neuromuscular inhibition (14)of the target muscle (3).

Additionally, the target muscle location (11) can be distinguished as alimited area or volume within a portion of the target muscle belly (29)which can be stimulated to increase muscle control (13) or decreaseneuromuscular inhibition (14) in contrast to conventional methods thatinclude general manipulation, massage or stimulation of the targetmuscle belly (29) to relax the target muscle (3). For example, a targetmuscle location (11) of the inventive method can be discretely limitedto a target muscle location area that includes a target muscle locationarea of between about 0.1% to about 5% of the area of target musclebelly (29). The target muscle location area can be a pre-determineddiscrete target muscle location (11), which without stimulation of agreater area of the target muscle belly (29), can upon stimulation actto increase muscle control (13) of the target muscle (3) of the subject(4) or decrease neuromuscular inhibition (14) of the target muscle (3)of the subject (4).

By way of contrast, conventional methods include general manipulation,massage, or stimulation of an area of the target muscle belly (29) muchgreater than 0.1% to about 5% of the area of the target muscle belly(29), for example, up to the entire manipulable surface area of thetarget muscle belly (29).

Now referring primarily to FIG. 2A, FIG. 2B, and FIG. 2C, the targetmuscle location (11) of the inventive method can be associated with aneuromuscular junction and locating the target muscle location (7) caninclude locating a target muscle location (7) in association with aneuromuscular junction. Generally, a neuromuscular junction can includea synapse (41) disposed between an efferent nerve fiber (42) and amuscle fiber (43) (as shown in the examples of FIG. 2A, FIG. 2B, andFIG. 2C). As described above, an action potential (18) can betransmitted from an efferent nerve fiber (42) to a muscle fiber (43),causing a cascade that can result in muscle contraction. As aneuromuscular junction can be involved with neuromuscular transmission,stimulation provided to the neuromuscular junction can modulateneuromuscular inhibition, for example by decreasing neuromuscularinhibition (14). Consequently, particular embodiments of the inventivemethod can further include locating a target muscle location (7)associated with a neuromuscular junction.

Now referring generally to FIG. 3 through FIG. 10, the inventive methodcan further include providing a stimulus (10) to a target musclelocation (11). As illustrative examples, a stimulus (12) suitable foruse with the inventive method can include one or more of: mechanicalstimulus, electrical stimulus, pharmacological stimulus, or the like, orcombinations thereof.

As to particular embodiments a stimulus (12) can include an amount ofpressure and providing a stimulus to a target muscle location (10) caninclude applying an amount of pressure to a target muscle location(10A). The amount of pressure can be delivered to a target musclelocation (11) by one or more fingertips (45) of a provider (46) (asshown in the examples of FIG. 4, FIG. 7, and FIG. 9); however, an amountof pressure can be delivered to a target muscle location (11) by one ormore various suitable pressure-generating members (47), includingelements of a hand such as a finger, a knuckle, a palm, a heel, ormechanical members having a configuration suitable for delivering anamount of pressure to a target muscle location (11), or the like, orcombinations thereof.

As to particular embodiments, the amount of pressure can be delivered toa target muscle location (11) discrete from delivery of an amount ofpressure to the remaining target muscle belly (29). Accordingly, as toparticular embodiments, the pressure-generating member (47) can beconfigured based upon the target muscle location area which can belesser or greater depending upon target muscle (3). For example, theamount of pressure can be applied by one fingertip (45) to a targetmuscle location (11) of corresponding lesser target muscle location areawhile the amount of pressure can be delivered by a plurality offingertips (45) to a target muscle location (11) of correspondinglygreater target muscle location area.

Now referring primarily to FIG. 5, FIG. 8, and FIG. 10, as to particularembodiments, the target muscle location (11) can include a target musclelocation area greater than the area engaged by the pressure-generatingmember (47). Accordingly, the pressure-generating member (47) can berepeatedly engaged with the target muscle location (11) along a targetmuscle location latitudinal axis or a target muscle locationlongitudinal axis (51).

As one illustrative example, the pressure-generating member (47) can bepositioned such that a pressure-generating member longitudinal axis canbe substantially perpendicular to the target muscle locationlongitudinal axis (51) to deliver the amount of pressure along thepressure-generating member longitudinal axis in substantiallyperpendicular relation to the target muscle belly longitudinal axis(51).

The amount of pressure can be selected from the group including orconsisting of: an amount of invariant continuous pressure, an amount ofsubstantially invariant continuous pressure, an amount of variantpressure, or combinations thereof. For example, substantially invariantcontinuous pressure can be delivered by engagement of thepressure-generating member (47) with the target muscle location (11) assubstantially constant maximum pressure amplitude over the period ofdelivery time and variant pressure can be delivered by engagement of thepressure-generating member (47) with the target muscle location (11) assubstantially inconstant maximum pressure amplitude over the period ofdelivery time (for example, a pulsatile pressure delivery).

As to particular embodiments, the amount of pressure delivered can be anamount of pressure (whether delivered as an invariant pressure or avariant pressure) which increases muscle control (13) of the targetmuscle (3) or an amount of pressure which decreases neuromuscularinhibition (14) of the target muscle (3). The amount of pressuredelivered to a target muscle location (11) can be lesser or greaterdepending upon the target muscle (3), the target muscle location (11),the degree of loss of muscle control or degree of neuromuscularinhibition, or combinations thereof. For example, a lesser amount ofpressure can be delivered to increase muscle control (13) or decreaseneuromuscular inhibition (14) in a target muscle (3) having a targetmuscle location (11) proximate the superficial anatomy of the subject(4), such as a gastrocnemius muscle. Alternatively, a greater amount ofpressure can be delivered to increase muscle control (13) or decreaseneuromuscular inhibition (14) in a target muscle (3) having a targetmuscle location (11) distal from the superficial anatomy of the subject(4), such as a soleus muscle.

As to particular embodiments, the amount of pressure delivered by thepressure-generating member (47) can depress the target muscle belly (29)at the target muscle location (11) a distance which acts to increasemuscle control (13) of the target muscle (3). Accordingly, applying anamount of pressure to a target muscle location (10A) can includedepressing a portion of a muscle belly at a target muscle location(10B). As to particular embodiments, the amount of pressure delivered tothe target muscle location (11) can decrease neuromuscular inhibition(14) of the target muscle (3). Consequently, the amount of pressure canact to increase neuromuscular transmission, likely by modulating one ormore components of the neuromuscular transmission cascade. The list ofcomponents of the neuromuscular transmission cascade described above isnot comprehensive. As such, the amount of pressure delivered canmodulate one or more of the components described above as well asadditional components of the neuromuscular transmission cascade omittedfrom the above description. As an illustrative example, the amount ofpressure can act to stimulate release of neurotransmitters (16) from thesynaptic end bulb (19) into the synaptic cleft (22).

Embodiments can further include delivery of the amount of pressure overa time period. As to particular embodiments, applying an amount ofpressure to a target muscle location (10A) can include depressing aportion of a muscle belly at a target muscle location for a time period(10C). The time period can range from between about one second to abouttwenty seconds. The time period can be selected from the group includingor consisting of: between about 1 second and about 3 seconds, betweenabout 2 seconds and about 4 seconds, between about 3 seconds and about 5seconds, between about 4 seconds and about 6 seconds, between about 5seconds and about 7 seconds, between about 6 seconds and about 8seconds, between about 7 seconds and about 9 seconds, between about 8seconds and about 10 seconds, between about 9 seconds and about 11seconds, between about 10 seconds and about 12 seconds, between about 11seconds and about 13 seconds, between about 12 seconds and about 14seconds, between about 13 seconds and about 15 seconds, between about 14seconds and about 16 seconds, between about 15 seconds and about 17seconds, between about 16 seconds and about 18 seconds, between about 17seconds and about 19 seconds, and between about 18 seconds and about 20seconds.

As an illustrative example, an amount of pressure can be delivered tothe target muscle location (11) as an amount of pressure having aconstant maximum amplitude of about two seconds. As another illustrativeexample, the amount of pressure can be delivered to the target musclelocation (11) as an amount of pressure having an inconstant maximumamplitude of pulsatile form incorporating five pulses, each pulse ofabout two seconds.

Now referring primarily to FIG. 12, as to particular embodiments, theinventive method can further include locating a target muscle second end(53), locating a target muscle second location (54) a second distancefrom the target muscle second end (53), and providing a second stimulus(56) to the target muscle second location (54), each as above describedfor the corresponding method of locating a first target muscle firstend, locating a target muscle first location (7), and providing a firststimulus (10) to the target muscle first location (7).

As to particular embodiments, providing a first stimulus (10) to atarget muscle first location (7) and providing a second stimulus (56) toa target muscle second location (54) can be delivered, as abovedescribed, either concurrently or serially to increase muscle control(13) or decrease neuromuscular inhibition (14).

Now referring primarily to FIG. 13, as to particular embodiments of theinventive physical therapy method (1), the inventive method can furtherinclude a functional screen (57), which can identify biomechanicaldeficiencies of a subject (4). A functional screen (57) can comprise anassessment of a subject (4), including a weight-bearing assessment, anactive assessment, a multiplanar assessment, a total body assessment, orthe like, or combinations thereof. Additionally, a functional screen(57) can comprise an assessment of actions of a subject (4), includingactions that mimic Activities of Daily Living, actions that mimic sportactivities, actions that mimic work activities, or the like, orcombinations thereof. Biomechanical deficiencies of a subject (4)identified by the functional screen (57) can facilitate in locating atarget muscle (5) by directing a provider (46) toward a target muscle(3) associated with a particular biomechanical deficiency.

Again referring primarily to FIG. 13, as to particular embodiments, theinventive method can further include testing neuromuscular facilitation(58), which can assess the ability of a target muscle (3) to contract asa result of communication with the nervous system. As to particularembodiments, testing neuromuscular facilitation (58) can includepositioning a target muscle (58A) between a midrange of motion and ashortened range of motion. As to other particular embodiments, testingneuromuscular facilitation (58) can include measuring a neuromuscularresponse (58B) of the target muscle (3) positioned between a midrange ofmotion and a shorted range of motion to a neuromuscular facilitationtest stimulus. As to yet other particular embodiments, testingneuromuscular facilitation (58) can include scoring the neuromuscularresponse (58C) of the target muscle (3) positioned between a midrange ofmotion and a shorted range of motion to the neuromuscular facilitationtest stimulus based on a binary determination of whether the targetmuscle (3) contracts in response to the neuromuscular facilitation teststimulus or the target muscle (3) does not contract in response to theneuromuscular facilitation test stimulus. As to still yet otherparticular embodiments, the inventive physical therapy method (1) caninclude providing a first stimulus (10) to the target muscle (3) whichdoes not contract in response to the neuromuscular facilitation teststimulus.

Again referring primarily to FIG. 13, as to particular embodiments, theinventive method can further include repeating: positioning the targetmuscle (58A), measuring the neuromuscular response (58B) of the targetmuscle (3), scoring the neuromuscular response (58C) of the targetmuscle (3), and providing the first stimulus (10) to the target muscle(3) until the target muscle (3) contracts in response to theneuromuscular facilitation test stimulus.

Example 1

Now referring primarily to FIG. 3 through FIG. 6 which show a firstillustrative example of the inventive method of increasing musclecontrol (13) or decreasing neuromuscular inhibition (14) of thegastrocnemius muscle.

Now referring primarily to FIG. 5, the gastrocnemius muscle, a posteriormuscle of the calf of the lower leg (59) has a lateral head whichoriginates from the lateral condyle of the femur, while thegastrocnemius muscle medial head originates from the medial condyle ofthe femur. The opposing end of the gastrocnemius muscle couples to theAchilles tendon, which inserts into the posterior surface of the heelbone. Actions of the gastrocnemius muscle can pull the heel upward andcorrespondingly extend the foot downward. Actions of the gastrocnemiusmuscle can also pull the lower leg (11) towards the posterior upper leg(73), causing knee joint (62) flexion. Accordingly, the gastrocnemiusmuscle can be involved with movements including standing, walking,running, jumping, or the like, or combinations thereof.

The subject (4) was positioned on a support surface (28) to allow accessto the gastrocnemius muscle in the posterior lower leg (59). In theinstant example, the subject (4) was positioned in a supine position,the leg including the gastrocnemius muscle flexed at the knee joint (62)with the foot (63) resting flat on the support surface (28) such thatthe foot (63) was in a plantar flexed position.

The gastrocnemius muscle within the lower leg (59) of the subject (4)was located by manually palpating the Achilles tendon along asubstantially longitudinal axis from the Achilles tendon distal endtoward the Achilles tendon proximal end. Once the Achilles tendonproximal end was located, the gastrocnemius muscle distal first end waslocated adjacent to the Achilles tendon proximal end.

The gastrocnemius muscle first location was located a first distancefrom the gastrocnemius muscle distal first end by manually palpating thegastrocnemius muscle along a substantially longitudinal axis (51) fromthe gastrocnemius muscle distal first end toward the gastrocnemiusmuscle proximal second end, moving a first distance of about one inch toa discrete gastrocnemius muscle first location within a portion of thegastrocnemius muscle belly associated with a neuromuscular junction.

Once the gastrocnemius muscle first location was located, a firststimulus (12) was delivered to the gastrocnemius muscle at thegastrocnemius muscle first location in the form of an amount of pressureapplied by one or more fingertips (45) of the provider (46). The amountof pressure delivered to the gastrocnemius muscle first location wasadjusted until there was a measurable increase in the output force orrange of motion about the knee joint (62) of the subject (4).

Now referring primarily to FIG. 6, the range of motion about the kneejoint (62) of the subject (4) prior to administration of the inventivemethod was measured at about −20 degrees of knee extension (70).Administration of the inventive method, as above described, resulted ina range of motion about the knee joint (62) of about 0 degrees of kneeextension (71). Accordingly, administration of the inventive methodresulted in a 20 degree increase in range of motion about the knee joint(62) of the subject (4).

Example 2

Now referring primarily to FIG. 7 and FIG. 8, the inventive method wasadministered to the rectus femoris muscle of a subject (4).

The rectus femoris muscle, an anterior muscle of the upper leg (73), hasa straight head originating from the anterior inferior iliac spine andthe reflected head originating from the ilium above the acetabulum. Theopposing end of the rectus femoris muscle inserts into the patella, orknee cap, via the quadriceps tendon. Actions of the rectus femorismuscle can include flexing the thigh at the hip joint and extending thelower leg at the knee joint.

The subject (4) was positioned on a support surface (28) in a supineposition, the leg including the rectus femoris muscle bolstered at theknee joint (62) allowing access to the rectus femoris muscle in theanterior upper leg (73).

The rectus femoris muscle within the upper leg (73) of the subject (4)was located by manually palpating the tendon (33) coupling the rectusfemoris muscle proximal first end with the anterior inferior iliac spinealong a substantially longitudinal axis (51) from the tendon proximalend (76) toward the tendon distal end (77). Once the tendon distal end(77) was located, the rectus femoris muscle proximal first end can belocated adjacent to the tendon distal end (77).

A rectus femoris muscle first location was located a first distance fromthe rectus femoris muscle proximal first end by manually palpating therectus femoris muscle along a substantially longitudinal axis (51) fromthe rectus femoris muscle proximal first end toward the rectus femorismuscle distal second end, moving a first distance of about one inch to adiscrete rectus femoris muscle first location within a portion of therectus femoris muscle associated with a neuromuscular junction.

Upon locating the rectus femoris muscle first location, the inventivemethod further included providing a first stimulus (10) to the rectusfemoris muscle at the rectus femoris muscle first location, the firststimulus (12) including an amount of pressure applied by one or morefingertips (45) of the provider (46) until an increase in muscle controlof the rectus femoris muscle was observed in the subject (4). As toparticular embodiments, the increase in muscle control of the rectusfemoris muscle can be assessed by testing rectus femoris muscleneuromuscular facilitation.

Example 3

Now referring primarily to FIG. 9 through FIG. 10, the inventive methodwas applied to the biceps brachii muscle of a subject (4).

Now referring primarily to FIG. 10, the biceps brachii muscle, atwo-headed anterior muscle of the upper arm includes a long head whichoriginates from the supraglenoid tubercle and a short head whichoriginates from the coracoid process of the scapula. The opposing end ofthe biceps brachii muscle inserts into the radial tuberosity. Actions ofthe biceps brachii muscle include flexing the elbow (85) and supinatingthe forearm (86).

The subject (4) was positioned in a supine position on a support surface(28) with the arm including the biceps brachii muscle flexed at theelbow (85) to allow access to the biceps brachii muscle in the anteriorupper arm of the subject (4).

The long head of the biceps brachii muscle within the upper arm of thesubject (4) was located by manually palpating the tendon coupling thelong head of the biceps brachii proximal first end with the supraglenoidtubercle along a substantially longitudinal axis (51) from the tendonproximal end toward the tendon distal end. Once the tendon distal endwas located, the long head of the biceps brachii proximal first end waslocated adjacent to the tendon distal end.

The long head of the biceps brachii muscle first location was located afirst distance from the long head of the biceps brachii muscle proximalfirst end by manually palpating the long head of the biceps brachiimuscle along a substantially longitudinal axis (51) from the long headof the biceps brachii muscle proximal first end toward the long head ofthe biceps brachii muscle distal second end, moving a first distance ofabout one inch to a discrete long head of the biceps brachii musclefirst location within a portion of the long head of the biceps brachiimuscle belly associated with a neuromuscular junction.

Once the long head of the biceps brachii muscle first location waslocated, a first stimulus (12) was delivered to the long head of thebiceps brachii muscle at the long head of the biceps brachii musclefirst location in the form of an amount of pressure delivered as fivepulses each over a time period of about two seconds, which resulted in ameasured increase in the muscle control of the biceps brachii muscle ofthe subject (4).

As a second illustrative example, the range of motion about the shoulderjoint (93) of a subject (4) prior to administration of the inventivemethod can be measured at about 120 degrees of shoulder flexion (94).Administration of the inventive method, as above described, can resultin about 180 degrees of shoulder flexion (95). Accordingly,administration of the inventive method can result in a 60 degreeincrease in range of motion about the shoulder joint (93) of the subject(4).

Example 4

Now referring primarily FIG. 11 and Table 1, the inventive method canresult in an increase in output force (96) of a target muscle (3) of asubject (4). In an experiment, twenty-two subjects (97) having decreasedmuscle control or neuromuscular inhibition of a rectus femoris musclewere tested. Rectus femoris muscle output force (96) was assessed usinga dynamometer both before administration of the inventive method andafter administration of the inventive method.

Now referring to Table 1, each subject (4) was given a numericalidentifier as shown in column one. The rectus femoris muscle outputforce (96) of each subject (4) prior to administration of the inventivemethod was recorded in column two as pounds of pressure. The rectusfemoris muscle output force (96) after administration of the inventivemethod was recorded in column three as pounds of pressure. The percentincrease (98) in output force (96) following administration of theinventive method (22) to each subject (4) was calculated and recorded incolumn four.

TABLE 1 Subject Output Output Percent Number Force Before Force AfterIncrease 1 24.0 27.0 12.5 2 26.6 29.6 11.3 3 26.5 27.1 2.3 4 22.0 24.913.2 5 28.7 36.4 26.8 6 15.2 18.5 21.7 7 15.1 15.9 5.3 8 31.6 32.9 4.1 925.9 32.6 25.9 10 37.5 39.9 6.4 11 33.7 39.7 17.8 12 32.7 38.3 17.1 1325.5 35.6 39.6 14 43.1 45.7 10.7 15 47.2 55.9 14.2 16 30.6 32.3 5.6 1728.6 33.5 17.2 18 22.8 26.8 17.2 19 21.5 25.3 17.2 20 25.5 29.8 17.2 2140.4 47.3 4.7 22 15.2 17.6 15.2

Now referring primarily to FIG. 11, the percent increase (98) in rectusfemoris muscle output force (96) following administration of theinventive method was plotted as a bar graph with each subject (4)identified along the horizontal axis (99) and each corresponding percentincrease (98) in rectus femoris muscle output force (96) shown along thevertical axis (100). Overall, the average percent increase (98) inrectus femoris muscle output force (96) following administration of theinventive method was 14.7%.

As to particular embodiments of the inventive physical therapy method(1), increasing muscle control (13) can include decreasing neuromuscularinhibition (14), increasing neuromuscular transmission of a targetmuscle (13A), stimulating contraction of a target muscle (13B),alleviating a symptom associated with loss of muscle control of a targetmuscle (13C), or the like, or combinations thereof

As to particular embodiments of the inventive physical therapy method(1), an increase in muscle control (13) or a decrease in neuromuscularinhibition (14) can result in a measureable result. As such, theinventive physical therapy method (1) can include measuring the musclecontrol of the target muscle (3). As to particular embodiments,measuring the muscle control of the target muscle (3) can includemeasuring a range of motion of a body part associated with extension orcontraction of the target muscle (3), measuring an output force of thetarget muscle (3), measuring a movement of a body part associated withextension or contraction of the target muscle (3), measuring a postureof a subject (4), the posture associated with extension or contractionof the target muscle (3), or the like, or combinations thereof.

As to particular embodiments of the inventive physical therapy method(1), an increase in muscle control (13) or a decrease in neuromuscularinhibition (14) can result in a measureable result including anachievement of a movement. For example, prior to providing methodsincluded in the inventive physical therapy method (1) to a subject (4),the subject (4) may not be able to step off of a curb. However, afterthe methods included in the inventive physical therapy method (1) areprovided, the subject (4) may be able to achieve the movement(s)sufficient to step off of a curb.

As to particular embodiments of the inventive physical therapy method(1), an increase in muscle control (13) or a decrease in neuromuscularinhibition (14) can result in a measureable result including anachievement of a posture. For example, prior to providing methodsincluded in the inventive physical therapy method (1) to a subject (4),the subject (4) may not be able touch their toes with their fingertipswhile standing straight-legged. After the methods included in theinventive physical therapy method (1) are provided, the subject (4) maybe able to touch their toes with their fingertips.

As to particular embodiments of the inventive physical therapy method(1), administration of the inventive method can result in an increase inmuscle control (13) or a decrease in neuromuscular inhibition (14) inthe target muscle (3) or in one or more muscles related to or unrelatedto the target muscle (3). As to particular embodiments, the inventivephysical therapy method (1) can effect tension in a muscle opposing thetarget muscle (3) via reciprocal inhibition.

As can be easily understood from the foregoing, the basic concepts ofthe present invention may be embodied in a variety of ways. Theinvention involves numerous and varied embodiments of the inventivephysical therapy system and methods for using such inventive physicaltherapy systems, including the best mode.

As such, the particular embodiments or elements of the inventiondisclosed by the description or shown in the figures or tablesaccompanying this application are not intended to be limiting, butrather exemplary of the numerous and varied embodiments genericallyencompassed by the invention or equivalents encompassed with respect toany particular element thereof. In addition, the specific description ofa single embodiment or element of the invention may not explicitlydescribe all embodiments or elements possible; many alternatives areimplicitly disclosed by the description and figures.

It should be understood that each element of an apparatus or each stepof a method may be described by an apparatus term or method term. Suchterms can be substituted where desired to make explicit the implicitlybroad coverage to which this invention is entitled. As but one example,it should be understood that all steps of a method may be disclosed asan action, a means for taking that action, or as an element which causesthat action. Similarly, each element of an apparatus may be disclosed asthe physical element or the action which that physical elementfacilitates. As but one example, the disclosure of a “palpation” shouldbe understood to encompass disclosure of the act of “palpating”—whetherexplicitly discussed or not—and, conversely, were there effectivelydisclosure of the act of “palpating”, such a disclosure should beunderstood to encompass disclosure of a “palpation” and even a “meansfor palpating.” Such alternative terms for each element or step are tobe understood to be explicitly included in the description.

In addition, as to each term used it should be understood that unlessits utilization in this application is inconsistent with suchinterpretation, common dictionary definitions should be understood to beincluded in the description for each term as contained in the RandomHouse Webster's Unabridged Dictionary, second edition, each definitionhereby incorporated by reference.

All numeric values herein are assumed to be modified by the term“about”, whether or not explicitly indicated. For the purposes of thepresent invention, ranges may be expressed as from “about” oneparticular value to “about” another particular value. When such a rangeis expressed, another embodiment includes from the one particular valueto the other particular value. The recitation of numerical ranges byendpoints includes all the numeric values subsumed within that range. Anumerical range of one to five includes for example the numeric values1, 1.5, 2, 2.75, 3, 3.80, 4, 5, and so forth. It will be furtherunderstood that the endpoints of each of the ranges are significant bothin relation to the other endpoint, and independently of the otherendpoint. When a value is expressed as an approximation by use of theantecedent “about,” it will be understood that the particular valueforms another embodiment. The term “about” generally refers to a rangeof numeric values that one of skill in the art would consider equivalentto the recited numeric value or having the same function or result.Similarly, the antecedent “substantially” means largely, but not wholly,the same form, manner or degree and the particular element will have arange of configurations as a person of ordinary skill in the art wouldconsider as having the same function or result. When a particularelement is expressed as an approximation by use of the antecedent“substantially,” it will be understood that the particular element formsanother embodiment.

Moreover, for the purposes of the present invention, the term “a” or“an” entity refers to one or more of that entity unless otherwiselimited. As such, the terms “a” or “an”, “one or more” and “at leastone” can be used interchangeably herein.

Thus, the applicant(s) should be understood to claim at least: i) theinventive physical therapy system herein disclosed and described, ii)the related methods disclosed and described, iii) similar, equivalent,and even implicit variations of each of these devices and methods, iv)those alternative embodiments which accomplish each of the functionsshown, disclosed, or described, v) those alternative designs and methodswhich accomplish each of the functions shown as are implicit toaccomplish that which is disclosed and described, vi) each feature,component, and step shown as separate and independent inventions, vii)the applications enhanced by the various systems or componentsdisclosed, viii) the resulting products produced by such systems orcomponents, ix) methods and apparatuses substantially as describedhereinbefore and with reference to any of the accompanying examples, x)the various combinations and permutations of each of the previouselements disclosed.

The background section of this patent application provides a statementof the field of endeavor to which the invention pertains. This sectionmay also incorporate or contain paraphrasing of certain United Statespatents, patent applications, publications, or subject matter of theclaimed invention useful in relating information, problems, or concernsabout the state of technology to which the invention is drawn toward. Itis not intended that any United States patent, patent application,publication, statement or other information cited or incorporated hereinbe interpreted, construed or deemed to be admitted as prior art withrespect to the invention.

The claims set forth in this specification, if any, are herebyincorporated by reference as part of this description of the invention,and the applicant expressly reserves the right to use all of or aportion of such incorporated content of such claims as additionaldescription to support any of or all of the claims or any element orcomponent thereof, and the applicant further expressly reserves theright to move any portion of or all of the incorporated content of suchclaims or any element or component thereof from the description into theclaims or vice-versa as necessary to define the matter for whichprotection is sought by this application or by any subsequentapplication or continuation, division, or continuation-in-partapplication thereof, or to obtain any benefit of, reduction in feespursuant to, or to comply with the patent laws, rules, or regulations ofany country or treaty, and such content incorporated by reference shallsurvive during the entire pendency of this application including anysubsequent continuation, division, or continuation-in-part applicationthereof or any reissue or extension thereon.

Additionally, the claims set forth in this specification, if any, arefurther intended to describe the metes and bounds of a limited number ofthe preferred embodiments of the invention and are not to be construedas the broadest embodiment of the invention or a complete listing ofembodiments of the invention that may be claimed. The applicant does notwaive any right to develop further claims based upon the description setforth above as a part of any continuation, division, orcontinuation-in-part, or similar application.

The invention claimed is:
 1. A method for treating a target musclehaving weak muscle contraction output force, comprising: identifyingsaid target muscle having said weak muscle contraction output force;measuring muscle contraction output force of said target muscle with adynamometer prior to treatment of said target muscle; subsequent tomeasuring said muscle contraction output force of said target muscle,treating the target muscle with a treatment, comprising: identifyingcorresponding origin and attachment of said target muscle; applying afirst amount of pressure to only a target muscle belly first end adistance from said origin of said target muscle along a target musclebelly longitudinal axis with a first pressure-generating member; andapplying a second amount of pressure to only a target muscle bellysecond end a distance from said attachment of said target muscle alongsaid target muscle belly longitudinal axis with a secondpressure-generating member; and subsequent to treating said targetmuscle with said treatment, measuring said muscle contraction outputforce of said target muscle with said dynamometer, wherein saidtreatment to the target muscle results in an increase in said musclecontraction output force as measured with said dynamometer.
 2. Themethod of claim 1, further comprising repeating application of saidfirst and second amounts of pressure to corresponding said target musclebelly first and second ends until said muscle contraction output forceof said target muscle increases as measured with said dynamometer. 3.The method of claim 1, wherein said treatment further comprisesadjusting amount of said first amount of pressure to said target musclebelly first end a distance from said origin of said target muscle oradjusting amount said second amount of pressure to said target musclebelly first end a distance from said origin of said target muscle untilsaid muscle contraction output force of said target muscle increases asmeasured with said dynamometer.
 4. The method of claim 1, wherein saidfirst amount of pressure applied prior to said second amounts ofpressure.
 5. The method of claim 1, further comprising functionallyscreening a subject prior to identifying said target muscle having saidweak muscle contraction output force.
 6. The method of claim 5, whereinsaid functionally screening comprises assessing a weight-bearingactivity.
 7. The method of claim 5, wherein said functionally screeningcomprises assessing an active activity.
 8. The method of claim 5,wherein said functionally screening comprises assessing a multiplanaractivity.
 9. The method of claim 5, wherein said functionally screeningcomprises assessing a total body activity.
 10. The method of claim 5,wherein said functionally screening comprises assessing actions thatmimic activities of daily living of said subject.
 11. The method ofclaim 5, wherein said functionally screening comprises assessing actionsthat mimic sport activities of said subject.
 12. The method of claim 5,wherein said functionally screening comprises assessing actions thatmimic work activities of said subject.
 13. The method of claim 1,further comprising functionally screening a subject after theapplication of said first and second amounts of pressure tocorresponding said target muscle belly first and second ends.
 14. Themethod of claim 1, further comprising positioning said target musclebetween a midrange of motion and a shortened range of motion to testneuromuscular facilitation.
 15. The method of claim 1, furthercomprising simultaneously applying said first and second amounts ofpressure to corresponding said target muscle belly first and secondends.